International Journal for Quality in Health Care Advance Access originally published online on April 14, 2005
International Journal for Quality in Health Care 2005 17(4):323-329; doi:10.1093/intqhc/mzi039
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Guidelines for preoperative assessment: impact on clinical practice and costs
1 ASO San Giovanni Battista, Università di Torino and CPO Piemonte, Unit of Cancer Epidemiology, Torino, Italy, 2 ASO San Giovanni Battista, 7th Unit of Anaesthesiology and Reanimation, Torino, Italy, 3 ASO San Giovanni Battista, 1st School of Anaesthesiology and Reanimation, Torino, Italy, 4 ASO San Giovanni Battista, Hospital Director, Torino, Italy
Objective. To describe preoperative evaluation in the San Giovanni Battista Hospital in Turin and to forecast the economic impact when preoperative assessment guidelines are implemented.
Design. We enrolled, in a month, 702 consecutive patients, excluding cardiac, thoracic, neuro- and vascular surgery, as well as emergency operations. Preoperative assessment data were collected individually, followed by simulating various applications of guidelines based on: (i) preoperative tests relying on full medical history and physical examination to discriminate preoperative risk patients; (ii) organization of a preoperative evaluation unit and tests before patient hospitalization.
Main measures. Mean number of tests prescribed, preoperative assessment cost per patient.
Results. The application of preoperative guidelines would decrease the mean number of tests prescribed from 20 laboratory and 1.9 instrumental to, respectively, 3 and 1.4 per patient. Tests deemed inappropriate by guidelines did not add any relevant clinical information to our study. Economic analysis estimates a reduction of 63% in cost per patient for preoperative tests by introducing guideline criteria (from 
69 to 26). As regards the cost per patient for preoperative evaluation and hospital stay (115 considering only variable costs, 580 including all costs), the application of the guidelines would reduce costs by 41–52% according to different cost evaluation approaches for hospital stay.
Conclusion. Preoperative guidelines fully introduced in practice could notably increase efficiency without affecting the quality of care.
Keywords: anaesthesiology, ASA classification, cost and cost analysis, hospital economics, practice guidelines, preoperative tests
Address reprint requests to Alberto Ferrando, Universita di Torino, Epidemiologia dei Tumori, Via Santena 7, 10126 Torino, Italy. E-mail: aferrando{at}molinette.piemonte.it
Accepted for publication March 6, 2005.